In a study of patients with erectile dysfunction, the mean AUC was increased by 21% to 29% and the mean Cmax was decreased by 19% in geriatric patients and 8% in younger patients (18 to 45 years) as compared to the 10 mg film-coated tablets. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Macimorelin: (Major) Concomitant use of vardenafil and macimorelin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Coadministration of ritonavir with vardenafil resulted in a 49-fold increase in vardenafil AUC and a 13-fold increase in vardenafil Cmax. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. For example, in patients whose hypertension was controlled with nifedipine, vardenafil produced mean additional supine systolic/diastolic blood pressure reductions of 3 to 4 mmHg (age group 65 to 69 years) and 5 to 6 mmHg (age group 70 to 80 years) compared to placebo. Patients should be reminded that vardenafil offers no protection against sexually transmitted disease. Ceritinib has been reported to cause concentration-dependent QT prolongation. For regular use, tadalafil can be a better fit. A decreased pressor effect of phenylephrine might occur. Generic for Levitra 20mg / 10mg can be brought online. Lapatinib: (Moderate) Concomitant use of vardenafil and lapatinib may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Coadministration with other strong CYP3A4 inhibitors increased the AUC of vardenafil by 10- to 16-fold. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Trifluoperazine is associated with a possible risk for QT prolongation. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Mefloquine: (Moderate) Concomitant use of vardenafil and mefloquine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. A decreased pressor effect of phenylephrine might occur. Vardenafil is not indicated for use in females. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Donepezil; Memantine: (Moderate) Concomitant use of vardenafil and donepezil may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. The degree of QT prolongation associated with rilpivirine is not clinically significant when administered within the recommended dosage range; QT prolongation has been described at 3 times the maximum recommended dose. Coadministration with another moderate CYP3A4 inhibitor increased the AUC of vardenafil by 4-fold. Use vardenafil with caution in patients with conditions that may increase the risk of QT prolongation including bradycardia, AV block, heart failure, stress-related cardiomyopathy, myocardial infarction, stroke, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances. Granisetron: (Moderate) Concomitant use of vardenafil and granisetron may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Sertraline: (Moderate) Concomitant use of vardenafil and sertraline may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Vardenafil is associated with QT prolongation. Perphenazine: (Minor) Use vardenafil with caution in combination with perphenazine due to increased risk of QT prolongation. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Tadalafil: (Major) Avoid coadministration of tadalafil and vardenafil. Lorcaserin: (Moderate) Lorcaserin is a serotonin 2C receptor agonist, and priapism is a potential effect of 5-HT2C receptor agonism. Vardenafil is primarily metabolized by CYP3A4/5; tucatinib is a strong CYP3A4 inhibitor. Inotuzumab Ozogamicin: (Major) Concomitant use of vardenafil and inotuzumab increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Coadministration with another moderate CYP3A inhibitor increased the AUC of vardenafil by 4-fold. Patients with mild hepatic impairment (Child-Pugh class A): No dose adjustment is required. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Sotalol: (Major) Concomitant use of vardenafil and sotalol increases the risk of QT/QTc prolongation and torsade de pointes (TdP). The effect of vardenafil on the QT interval should be considered when prescribing the drug. Brompheniramine; Phenylephrine: (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Do not administer with any liquids. This chart may not. Staxyns quick-dissolving formula absorbs through the capillary-rich area of skin that resides right under the tongue. Phosphodiesterase type 5 is responsible for degradation of cGMP in the corpus cavernosum. The degree of QT prolongation associated with rilpivirine is not clinically significant when administered within the recommended dosage range; QT prolongation has been described at 3 times the maximum recommended dose. Coadministration with another moderate CYP3A4 inhibitor increased the AUC of vardenafil by 4-fold. STAXYN provides higher systemic exposure compared to vardenafil 10 mg film-coated tablets (LEVITRA). Deaths have been reported in men who were using sildenafil while taking nitrate or nitrite therapy for angina. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Additive effects on blood pressure are also possible. Vardenafil is associated with QT prolongation. (See Clinical Trials.) The maximum recommended dose for STAXYN is 10 mg (one 10 mg orally disintegrating tablet) once daily. Drug information provided by: Merative, Micromedex US Brand Name. Levitra vs. Staxyn. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Conversely, patients already receiving an optimized dose of vardenafil should be started on the lowest dose of the alpha-blocker; increases in the alpha-blocker dose should be done in a stepwise fashion. The active ingredient goes to work quickly and effectively, hitting the bloodstream much faster than it would by being absorbed through the lining of the stomach. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Class IA antiarrhythmics are associated with QT prolongation and torsade de pointes (TdP). Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Erythromycin: (Major) Do not use vardenafil orally disintegrating tablets with erythromycin due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Patients with mild hepatic impairment do not require adjustments in the vardenafil tablet dosage. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Vardenafil and its major metabolite (M1) are highly bound to plasma proteins (approximately 95% for parent drug and M1). Pimavanserin: (Major) Concomitant use of vardenafil and pimavanserin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). The onset of action is within 1 hour of administration. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Pimozide: (Contraindicated) Avoid concomitant use of vardenafil and pimozide due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. ED is often a symptom of another health problem or health-related factor. Coadministration with other strong CYP3A4 inhibitors increased the AUC of vardenafil by 10- to 16-fold. Conversely, patients already receiving an optimized dose of vardenafil should be started on the lowest dose of the alpha-blocker; increases in the alpha-blocker dose should be done in a stepwise fashion. Both pills use the drug Vardenafil as their active ingredient. Adagrasib: (Major) Avoid concomitant use of adagrasib and vardenafil due to the potential for increased vardenafil exposure and additive risk for QT/QTc prolongation and torsade de pointes (TdP). Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. - Uncommon (0.1-1%): fast heart rate, palpitations, tinnitus, dizziness, drowsiness, stomach pain, diarrhea, vomiting, dry mouth, skin rash, allergic reaction, visual disturbances (glare, changes. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. The patient should be monitored carefully and the dosage should be adjusted based on clinical response. In a double-blind, crossover, single-dose study of patients with stable CAD, vardenafil did not cause any impairment in exercise capabilities at levels equivalent to or greater than that achieved during sexual intercourse. Risperidone: (Moderate) Concomitant use of vardenafil and risperidone may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Vardenafil is primarily metabolized by CYP3A4/5; letermovir is a moderate CYP3A4 inhibitor. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Coadministration of other drugs that also prolong the QT interval may result in additive QT prolongation. Safety and efficacy have not been established. Affected Cytochrome P450 (CYP450) isoenzymes and drug transporters: CYP3A4, P-glycoprotein (P-gp)Vardenafil is primarily a substrate of CYP3A4. Berotralstat: (Major) Do not use vardenafil orally disintegrating tablets with berotralstat due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Sorafenib: (Major) Concomitant use of vardenafil and sorafenib increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Monitor for proper blood pressure when these drugs are used together. Relugolix; Estradiol; Norethindrone acetate: (Moderate) Concomitant use of vardenafil and androgen deprivation therapy (i.e., relugolix) may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Olanzapine; Fluoxetine: (Moderate) Concomitant use of vardenafil and fluoxetine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. First, we ask if the medicine is effective. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Imatinib: (Major) Do not use vardenafil orally disintegrating tablets with imatinib due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Max: 1 dose/day and 20 mg/dose. Fluconazole: (Contraindicated) Avoid concomitant use of vardenafil and fluconazole due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. Letermovir: (Major) Do not use vardenafil orally disintegrating tablets with letermovir due to increased vardenafil exposure; do not exceed a single dose of 5 mg per 24-hour period of vardenafil oral tablets. Mobocertinib: (Major) Concomitant use of mobocertinib and vardenafil increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Erectile dysfunction (ED) is often a symptom . There was no need to worry about the effectiveness of the medication or plan things in advance. Monitor for signs and symptoms of hypotension during transition of therapy. Loperamide: (Moderate) Concomitant use of vardenafil and loperamide may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of vardenafil and rilpivirine may increase the risk of QT/QTc prolongation and torsade de pointes (TdP) in some patients. Pazopanib: (Major) Concomitant use of vardenafil and pazopanib increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Caution should be exercised when administering sapropterin in combination with drugs that affect nitric oxide-mediated vasorelaxation such as phosphodiesterase inhibitors. The median time to reach Cmax in a fasted stated was 1.5 hours (range: 45 minutes to 2.5 hours). Coadministration with other strong CYP3A4 inhibitors increased the AUC of vardenafil by 10- to 16-fold. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Coadministration with another moderate CYP3A4 inhibitor increased the AUC of vardenafil by 4-fold. Methadone: (Major) Concomitant use of vardenafil and methadone increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Common side effects of vardenafil include headache, flushing, and stuffy nose. Vardenafil is primarily metabolized by CYP3A4/5; nefazodone is a strong CYP3A4 inhibitor. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Vardenafil is contraindicated in individuals who are currently on nitrate/nitrite therapy or those taking guanylate cyclase (GC) stimulators. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Hydralazine; Isosorbide Dinitrate, ISDN: (Contraindicated) Coadministration of phosphodiesterase inhibitors with organic nitrates or nitrites in any dosage formulation is contraindicated. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. Vardenafil is primarily metabolized by CYP3A and erythromycin is a moderate CYP3A inhibitor. (Minor) The therapeutic effect of phenylephrine injection may be decreased in patients receiving phosphodiesterase inhibitors. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Class IA antiarrhythmics are associated with QT prolongation and torsade de pointes (TdP). Vardenafil is primarily metabolized by CYP3A4/5; cobicistat is a strong CYP3A4 inhibitor. Consider taking steps to minimize the risk of QT/QTc interval prolongation and TdP, such as avoidance, electrolyte monitoring and repletion, and ECG monitoring, especially in patients with additional risk factors for TdP. 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